Organization
THE SHIELD OF DAVID, INC.
Active
Organization
THE SHIELD OF DAVID, INC.
Active
Other names
The Shield Institute
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN PROVENZANO (EXECUTIVE DIRECTOR)
(718) 886-1682
Entity
Organization
Contact information
Practice address
3909 214TH PL, BAYSIDE, NY 11361-2123
(718) 269-2004
Mailing address
144-61 ROOSEVELT AVENUE, FLUSHING, NY 11354
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
6593164
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00243949
—
NY
Enumeration date
05/31/2006
Last updated
04/24/2018
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